1346355765 NPI number — SHELDON M KREMS PHD

Table of content: SHELDON M KREMS PHD (NPI 1346355765)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1346355765 NPI number — SHELDON M KREMS PHD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KREMS
Provider First Name:
SHELDON
Provider Middle Name:
M
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PHD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1346355765
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
20 DAVIS AVENUE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
POUGHKEEPSIE
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
12603-2408
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
845-485-3500
Provider Business Mailing Address Fax Number:
845-485-8780

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
510 HAIGHT AVENUE
Provider Second Line Business Practice Location Address:
SUITE 102 SPECTRUM BEHAVIORAL MANAGEMENT SERV INC
Provider Business Practice Location Address City Name:
POUGHKEEPSIE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12603-2408
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
845-485-3500
Provider Business Practice Location Address Fax Number:
845-485-8780
Provider Enumeration Date:
08/19/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 103TC0700X , with the licence number:  0053751 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 417561 . This is a "MVP HEALTH CARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 027181 . This is a "CDPHP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2112824 . This is a "CIGNA BEH HEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 5417729 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1033150 . This is a "BEACON HEALTH STRAT" identifier . This identifiers is of the category "OTHER".
  • Identifier: 000471040001 . This is a "BSNENY" identifier . This identifiers is of the category "OTHER".
  • Identifier: 6886068 . This is a "VALUE OPTIONS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 6886068 . This is a "GHI BMP" identifier . This identifiers is of the category "OTHER".